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“脾为之卫”不仅强调脾胃对水谷精微的运化作用，还阐明脾胃对营卫循行的影响。基于此认为脾为连接“肠道菌群-昼夜节律-营卫循行”的枢纽，脾的功能状态可以调节营卫的生成及循行从而影响肠道菌群，进而参与昼夜节律的调节，共同决定睡眠的正常与否。慢性失眠以脾失之卫导致营卫循行失常为核心病机，治疗应以健脾和营卫以恢复昼精夜瞑为原则，健脾益营以行阴，方用小建中汤、归脾汤加减；行脾布卫以助阳，方用厚姜半甘人参桂枝汤加减；调和营卫以达昼精夜瞑，方用桂枝新加汤加减。通过探讨肠道菌群、昼夜节律与营卫循行三者之间的内在联系，旨在为从脾调控营卫生成及循行治疗失眠提供新视角。
Abstract：The theory that "spleen functions as wei qi" not only emphasizes the spleen and stomach's role in transforming and transporting food essence, but also elucidates their influence on the circulation of ying and wei qi. On this basis, the spleen is regarded as the pivotal link connecting the "gut microbiota-circadian rhythm-ying-wei circulation" axis. The functional state of the spleen can regulate the generation and circulation of ying and wei, thereby influencing the gut microbiota and participating in the regulation of circadian rhythms, together determining the normality of sleep. Chronic insomnia is characterized by spleen failure in its guarding function, leading to disordered ying-wei circulation as the core pathomechanism. Treatment should focus on strengthening the spleen and harmonizing ying and wei to restore "clarity during the day and sleep at night". To tonify the spleen and enrich ying to facilitate yin movement, modified Xiaojianzhong Decoction （小建中汤） and Guipi Decoction （归脾汤） are recommended; to activate the spleen and distribute wei to support yang, modified Houjiang Bangan Renshen Guizhi Decoction （厚姜半甘人 参 桂 枝 汤） is used; to regulate ying and harmonize wei to achieve "clarity during the day and sleep at night", modified Guizhi Xinjia Decoction （桂枝新加汤） is applied. By exploring the intrinsic connections among gut microbiota, circadian rhythms, and ying-wei circulation, this study aims to provide a new perspective for treating insomnia through spleen-based regulation of ying-wei generation and circulation.
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基本信息:
DOI：10.13288/j.11-2166/r.2026.06.006
中图分类号:R256.23
引用信息:
[1]高钰,王蒙,李宇曦,等.基于“脾为之卫”理论从“肠道菌群-昼夜节律-营卫循行”论治慢性失眠[J].中医杂志,2026,67(06):619-624.DOI:10.13288/j.11-2166/r.2026.06.006.
基金信息:
国家重点研发计划（2024YFC3506300,2024YFC3506303）; 中医药广东省实验室（HQL2024PZ034）; 第二届广东省中医院优秀中医临床人才研修项目（中医二院[2024]88号）